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Full text of "United States Navy Medical News Letter Vol. 44 No. 12, 25 December 1964"

NAVMED P-3088 




Reason's Greeting* 

In contrast with the countless stresses of our times, it is immediately evident that 
the spirit of man throughout Christendom is a splendid thing to behold at Christmas 
time. This is as it should be, for the deep and abiding Faith of these multitudes of 
people has been a constant companion in times of adversity and a pillar of strength 
in the face of disaster. Sheer happiness during the Christinas season is a genuine and 
spontaneous expression and its recurrence each year bespeaks its bona fide and per- 
manent qualities which for almost 2000 years have been perpetuated among mankind. 

To all members of our Medical Department whether serving at sea. ashore, or 
in a distant foreign land, I extend my best wishes for a Merry Christmas and a 
Happy New Year. 

To your loved ones, we owe a special debt of gratitude. Their faith in the future, 
their determination and adaptation to the process of periodic moves to new geographic 
areas, leaving behind their newly developed and closest friends — only to find new friends 
at their next station — all of these things are part and parcel of the Navy's strength. 
To these thousands of family members I also extend my deep appreciation for your 
devotion and moral support to your Navy man. May you also experience a holy and 
happy Holiday Season. 



c^2~~r*er.<£-- 



EDWARD C. KENNEY 
Rear Admiral, MC, USN 
Surgeon General 



United States Navy 
MEDICAL NEWS LETTER 



Vol. 44 



Friday, 25 December 1964 



No. 12 



Rear Admiral Edward C. Kenney MC USN 
Surgeon General 

Rear Admiral R. B. Brown MC USN 

Deputy Surgeon General 

Captain M. W. Arnold MC USN (Ret), Editor 
William A. Kline, Managing Editor 

Contributing Editors 

Aviation Medicine Captain C. E. Wilbur MC USN 

Dental Section Captain C. A. Ostrom DC USN 

Occupational Medicine CDR N. E. Rosenwinkel MC USN 

Preventive Medicine Captain J. W. Millar MC USN 

Radiation Medicine CDR J. H. Schulte MC USN 

Reserve Section Captain C. Cummings MC USNR 

Submarine Medicine CDR J. H. Schulte MC USN 



Policy 

The U.S. Navy Medical News Letter is basically an 
official Medical Department publication inviting the 
attention of officers of the Medical Department of the 
Regular Navy and Naval Reserve to timely up-to-date 
items of official and professional interest relative to 
medicine, dentistry, and allied sciences. The amount 
of information used is only that necessary to inform 
adequately officers of the Medical Department of the 
existence and source of such information. The items 
used are neither intended to be, nor are they, sus- 



ceptible to use by any officer as a substitute for any 
item or article in its original form. All readers of the 
News Letter are urged to obtain the original of those 
items of particular interest to the individual. 

Change of Address 

Please forward changes of address for the News Letter 
to: Commanding Officer, U.S. Naval Medical School, 
National Naval Medical Center, Bethesda, Maryland 
20014, giving full name, rank, corps, and old and new 
addresses. 



FRONT COVER: Original sketch designed for the Medical News Letter by Mrs. Josephine L. Bottazzi and Mrs. 
Sara B. Hannan of the Graphic Section, Administrative Publications and Printing Branch. Administration Divi- 
sion, Bureau of Medicine and Surgery. As staff artists and medical illustrators in BUMED, their dedicated serv- 
ices are available to and utilized by all divisions, branches and sections in this Bureau, at one time or another. 
Versatility, talent and keen insight into the areas of Medical Department activity which their work supports 
characterize these fine Civil Service career employees. To both, a hearty WELL DONE! — and a Merry Christmas 
and Happy New Year salute from the Medical News Letter staff. — Editor 

NOTICE: See back cover for contents of this issue. — Editor 



The issuance of this publication approved by the Secretary of the Navy on 4 May 1964. 

U.S. NAVY MEDICAL NEWS LETTER 



Postoperative Pain 



LT J. C C&ttmgham MC USN*. From the Proceedings of the Monthly Staff Con- 
ffanemrxif. V. S. Naval Hospital, NNMC, Bethesda, Md. 1963-1964. 



The pBiiiEiiraify grium and perspiring patient, fearful 
of mB&wfflg <m toEnsMnng- has become a constant fixture 
in the pffMffiHimsJiEajll wsmSs. His suffering was anticipated 
by Ms pflngsaciiaims audi its accepted in the knowledge that 
iitt wiil (iisaippKaor inn damme. This is the expected, the usual, 
aunrfl tie imswtetMs: [postoperative pain — probably the 
most iraqprantt amd! nmstt neglected painful state in the 
hasptoll stoamtnum. A mecemitt survey of narcotic practices 
ibm Jdffararam Dtoik HsMjntall in Houston disclosed that 
ttww-timinfe <a£ ad dimes of narcotics dispensed for in- 
patients ware uusdS am the surgical services and, of 
these, (flunBe-ftwartiis were used in the treatment of post- 
mpjHratliwE pariim.. 

The PfliiitouDpftiy off Paiim 

I^im — tits existentee and ills fears — has had a profound 
died ram mnaim's task philosophy since earliest of civ- 
iiiratikm. He the tfflnhM chapter of the book of Genesis it 
k Drafted! tttat Ceni saiidl to Eve after the eating of the 
fuMbikdUlam innit W I will gaesifly multiply thy sorrow and 
thy oanuceplliioinc ibm smsarm thou shah bring forth chil- 
dbnam-'" Mntt 00% was the judgment of God for the 
aTfnm nmniitiitiiiTOP <of the aniigjanial sin cast in the framework of 
BsadHy paiin, (bust,, md too have been the actions of rulers 
of states aumdl onJhiHrs iim authority toward those convicted 
(Oif arihnme.. Unwtoiulb*afly much thought has gone into 
dewnsingg mneaunis off pnmJondimg pain in the interest of 



Op lumffli tike fflnrodkffle of (the 19th century, Aristotle's 
pHtofBfflfftiir ffranffiepfl; of -pain being the opposite of 
pteasiunie wn& nBnif eapsreaukmt of unpleasantness" was ac- 
cepted! ttatrauaj^tomutt the world. Then came the "law of 
speriffie nnarwe emiHigiies"* set forth by Muller in 1840, 
whfch <rajim fee inmftnrpnatral to mean that each sensory 
eajauailliiitf has; ntts owmi specific sensory unit. The deveiop- 
smieimt off this cranmceptt has continued into the present day 
mill wpum it iis haisBftl inmost of what we have been taught 
ahouut sransatMons.. Themeffore, from Aristotle to the 
pmesemilL, iit Boas tafceiD mraaim 2,500 years to discard the 
mystica*™ assffloaftisdl with pain and finally approach the 



• Btaullom its tiftir AirosUiiKsioitogs Sentiic liSNH, NNMC, Bethesda, 

MUL fflWD*. 



subject scientifically. And it will probably take again 
that long to unravel the multitude of components which 
comprise the total pain experience of an individual. 

Pain Perception Vs. Reaction 

Pain has two components: the original sensation, and 
the reaction to that sensation. Before we as physicians 
can prescribe analgesics, we must understand not only 
which of the two components or both that we are treat- 
ing, but also how each varies among individuals. 

Much work has been done to evaluate patient's pain 
threshold in the belief that individual suffering was re- 
lated directly to the amount of pain stimulus. Beecher 
has shown that there is no correlation between pain 
threshold and the suffering experienced by the patient. 
A small dose of morphine which does not raise the pain 
threshold any more than a large dose of aspirin, is much 
more effective in relieving pain than the large dose of 
aspirin. Since the "perception" component in man is 
the principal site of action of analgesic drugs, the fol- 
lowing are a few characteristics of perception of pam 
that are specific: 

1. There is no constant, necessary, or proportionate 
relationship between perception of pain and the reaction 
to that perception. 

2. Intensity of pain perception arising from a lesion 
is independent of the size or location of the lesion. 

3. When two or more sources of pain stimuli exist 
coincidentally, perception is usually monopolized by 
the most intensive; it appears as if in competition for 
recognition by the central processing mechanism, one 
wins and is accepted and the others are more or less 
ignored. This may explain a patient's failure to com- 
plain of pain in one area such as the chest, when there 
is pain from another area such as the pelvis. This 
phenomenon is dependent upon apparent absence of 
summation. It is the basis for the device learned in 
childhood that the pain of sudden trauma, such as a 
bruise, can be alleviated by the institution of another, 
such as biting the lips. 

4. Though perception is relatively constant, it is 
amenable to modification: by drugs and by powerful 
emotional states. Thus the recently badly-wounded may 



IP. S. NAVY MEDICAL NEWS LETTER 



1 



show little or no evidence of pain, not only because re- 
action is diminished or absent, but also because percep- 
tion itself may be grossly disturbed. The patient, on 
questioning, may deny that he feels any pain. 

Pain reaction in contra-distinction to perception is 
widely variable among different individuals, and in the 
same individual from time to time. It has no definite 
localized apparatus of function. It is a cognitive process 
and thus, being affective, is under the influence of the 
whole gamut of the patient's experiences, emotions and 
needs, as well as the environmental circumstances at the 
moment. 

Although there is some objective evidence suggesting 
the existence of severe pain — (tachycardia, drawn 
facies, pallor, sweating) — reaction is largely immeasur- 
able. The manifestation of reaction is the patient's 
complaints and his physical and mental responses: they 
constitute pain reaction. 

Several important further characteristics of pain 
should be considered: 

1 . Pain varies widely in severity from time to time, 
and very severe pain does not persist unchanged for 
any protracted period. The pain of carcinomatoses is 
particularly prone to waxing and waning, 

2. Occasionally, severe and intractable pain from a 
known causative lesion such as a malignant mass or 
from trigeminal neuralgia may cease abruptly for no 
demonstrable reason, 

3. The presence of general disability, malnutrition, 
fatigue in any circumstance in which emotional stress 
or anxiety occurs makes the reaction to a given pain 
stimulus more marked or more difficult to treat. 

4. Tolerance for pain is a highly individualized trait. 
It is dependent upon many factors: cultural, familial, 
environmental. It frequently appears to be influenced 
by the patient's concept of what kind of reactions are 
appropriate or expected of him in the circumstances at 
hand. 

In a recent survey of 293 postoperative patients who 
were given alternate injections of normal saline and a 
narcotic in treatment of their pain, no less than 43.2 
percent of the 293 doses of saline resulted in relief. 
(Each dose was given within 20 hours after major ab- 
dominal procedures.) This great power strongly supports 
the view that drugs are capable of altering subjective 
responses and symptoms, and do so to an important 
degree through their effect upon the reaction com- 
ponent of suffering. Beecher has reported the results 
of 15 separate studies involving over 1,000 patients in 
which placebos were found to have an average sig- 
nificant effectiveness of 35.2 percent. These figures are 
supported by dozens of other experiments showing that 
the usual reported figure of 26 percent effectiveness of 
placebos may actually be a conservative statement. 

The "pharmacologic action" of placebos is not limited 
to pain relief. Beecher reports the following incidence 
of side reactions: dry mouth, 9 percent; nausea, 10 per- 



cent; sensation of heaviness, 18 percent; relaxation, 9 
percent; fatigue, 18 percent; sleep, 10 percent. He also 
reports patients developing rashes, angioneurotic edema, 
and constricted pupils, not only with the placebo, but 
also later with an injection of a narcotic. 

Most postoperative patients are not consistent placebo 
reactors or non-reactors, at times obtaining relief from 
placebos and other times not. This introduces a tem- 
poral characteristic apart from basic personality char- 
acteristics, in determining placebo response. This tem- 
poral characteristic may be dependent upon such things 
as day or night, visiting hours, time from operation, 
and implication of the patient's disease. In comparing 
a group of consistent placebo reactors with a group who 
consistently failed to obtain pain relief from placebo, 
there have been found significant differences in the 
attitudes, habits, educational backgrounds and person- 
ality structure between the patients. Yet the placebo 
reactor could not be identified by the casual observer, 
but could only be delineated by extensive and careful 
psychologic techniques. These investigations are stimu- 
lating further studies on the effect of personality char- 
acteristics of drug action. 

Characteristics of Postoperative Pain 

There are many misconceptions among physicians as 
to the severity of pain which follows certain surgical 
procedures, and more especially as to the relative merit 
of various drugs in its relief. These "clinical impres- 
sions" are prevalent because nurses, not physicians, give 
the drugs for postoperative pain. Observations made by 
some nurses may be based on criteria which do not 
necessarily coincide with good medical practice. Much 
of what is believed to be known about postoperative 
pain is the result of such observations as recorded in 
nursing notes. 

1 . Incidence. Periodically, investigators who use 
postoperative patients for their studies re-discover that 
many patients do not have pain following surgery. 
Papper, Brodie, and Rovenstine found that 44 percent 
of their 237 postoperative patients failed to complain 
of pain. Included in this group were 108 patients who 
had intra-abdominal or intra-thoracic procedures, and 
of these, 27 percent did not complain of pain. laggard, 
Zager, and Wilkins found that 36 percent of 1 ,005 
patients received no narcotics during the entire post- 
operative period. Keats reported 21 percent of 104 
patients who had undergone either gastrectomy or co- 
lectomy received one or no dose of narcotics during 
the entire postoperative period. Papper, Brodie and 
Rovenstine found that 58 percent of patients having 
surgery of the superficial parts of the body did not com- 
plain of pain after operation, in contrast to only 27 
percent for those having abdominal or thoracic pro- 
cedures. 

Pain is the postoperative patients chief complaint, 
but he may complain bitterly and primarily of symp- 



U. S. NAVY MEDICAL NEWS LETTER 



toms such as sleeplessness, discomfort from gastric tube 
or oxygen catheter, sore throat, headache, backache, 
uncomfortable position in bed, bladder discomfort from 
indwelling catheters, tightness and weightiness of casts, 
or discomfort from shivering in an air-conditioned 
room. These symptoms as primary complaints are re- 
sponsible for JO percent to 15 percent of all requests 
for medications, and narcotics are not required for 
their relief. 

2. Duration. Pain of severity sufficient to require 
narcotics usually disappears within 48 hours after 



surgery, with 87.4 percent of all doses of morphine 
following major intra-abdominal surgery being adminis- 
tered during this time. There is little need for narcotics 
after 48 hours. Exceptions to this usual time course 
are present in patients who develop certain surgical 
complications, as infection, and in patients who develop 
psychic dependence on the drug or the injection per se, 
or the associated care. Such exceptions are rare. Pain 
of lesser magnitude may persist for variable periods 
following operation and is readily controlled by non- 
narcotic analgesics. 



Frequency of Morphine Administration During 8-Hour Periods 
Following 60 Major Intra-Abdominal Surgical Procedures 

Hours Postoperatively 



No. of patients 


0-8 


8-16 


16-24 


24-32 


32-40 


40-48 


48+ 


Total 


Percent of 


57 


58 


39 


41 


18 


18 


34 


265 


Narcotic Doses 


21.5 


21.9 


14.7 


15.5 


6.8 


6.8 


12.8 


100 



Realizing that narcotics, as a rule, were necessary 
only during the first 48 postoperative hours, together 
with the knowledge that most prn narcotic orders were 
effective for the duration of hospitalization, Beecher 
and Keats at Massachusetts General Hospital attempted 
to estimate the magnitude of some of these abuses by 
comparing the amount of morphine a specific group 
of patients needs to the amount actually received. 
Thirty ward patients who had uncomplicated cho- 
lecystectomies by standard operative procedures under 
ether anesthesia were allowed to receive 10 mgm of 
morphine as often as every hour to control pain. They 
were kept comfortable at all times and given drugs for 
as long as necessary, postoperatively. For comparison, 
the hospital records of identical groups of ward, semi- 
private, and private patients were randomly collected 
and the amount of postoperative morphine they re- 
ceived was tabulated. The mean doses of morphine per 
patient (+ standard error) following cholecystectomies 
in these four groups were as follows: 
Ward group studies — 3.2 + 0.4 

Ward group, hospital records — 5.6 + 0.4 

Semi-private group, hospital records — 9.8 + 0.7 

Private group, hospital records — 13.4 + 1.2 

When these data were broken down into time in- 
tervals following operation, it was found that in the 
private group 40 percent of the total narcotics were 
administered more than 48 hours following surgery. 
Although there are many psychosocial implications in 
these data, the authors of these reports attributed the 
prolonged administration of narcotics to nursing prac- 
tices. For example, some nurses who were interviewed 
said they were taught that every postoperative patient 
must have two doses of morphine during the first post- 



operative night. Some nurses routinely give all post- 
operative patients a narcotic at 1 1:00 p. m. to guarantee 
a quiet night and time for manipulating their Cardex. 
3. Patient Variables. Efforts to correlate severity of 
postoperative pain with certain characteristics of the 
patients themselves have been largely unsuccessful. 
Most researchers have been unable to correlate the de- 
gree of postoperative pain to age, sex, type of anesthesia, 
duration of anesthesia, previous medical history, pre- 
vious surgical history, previous hospitalizations, ob- 
vious personality types, noticeable personality disorder, 
or presence of preoperative pain. Pain following sur- 
gery seems to be random with regard to obvious patient 
characteristics. 

Treatment of Postoperative Pain 

Parenteral injections are the accepted route of drug 
administration to the postoperative patient. Oral anal- 
gesics are not ideal because the disturbances of gastro- 
intestinal function so common following operation, 
result in unpredictable drug absorption. Most anal- 
gesics are ineffective via the oral route; the ineffective- 
ness of morphine by mouth has been noted by many 
observers, although this fact is still not generally ap- 
preciated. Beecher and Keats found that when 10 mg 
of morphine, 60 mg of codeine, 300 mg of aspirin, and 
600 mg of aspirin were given orally to postoperative 
patients, the only effective analgesic was 600 mg of 
aspirin. Neither morphine nor codeine could be dis- 
tinguished from a placebo under these circumstances. 

Parentally, no drug which has been adequately stud- 
ied has been found to produce the analgesia of mor- 
phine with less side reaction than morphine. Based on 
current information, all available narcotics with the 



U. S. NAVY MEDICAL NEWS LETTER 



exception of codeine, will produce adequate postopera- 
tive analgesia if given in equivalent dosage, and at this 
dose the same side actions might be expected as with 
morphine. (The analgesic potency of codeine does not 
equal that of morphine, even 120 mg, and at this dose, 
codeine is a potent respiratory depressant.) 

The dose-response curve, characteristic of drug action 
in general, applies to the analgesic properties of nar- 
cotics. An optimal dose can be determined, exceeding 
which further increase will not result in proportional 
increase in analgesia. For morphine in postoperative 
pain, the dose is 10 mg (1/6 grain) per 70 Kg of body 
weight. The significant increase in side reaction, such 
as nausea, vomiting, and respiratory depression, occurs 
at higher doses in return for small additional analgesia. 



Relationship Between Dose of Morphine 

and Incidence of Analgesia 

Greater than Placebo 



Incidence of Pain Relief fof 

According to Omdtar 

Postoperative Doses inn 199 



Dose per 






Percent Analgesic 


70 Kg of 


No. of 


No. of 


Doses Greater 


Body Weight 


patients 


doses 


than Placebo 


5 


56 


109 


25.7 


10 


38 


71 


35.2 


15 


31 


59 


37.3 


20 


18 


40 


37.5 



Pain occurring earlier in the postoperative period is 
more difficult to relieve than that occurring after 24 
hours. Effective pain relief as compared to order of 
doses, shows only 63 percent relief from the first dose 
with the effectiveness progressing to 89 percent by the 
fourth administration postoperatively. 



Dose No. 


1 


2 


3 


4+ 


No. of 










Administrations 


19% 


DD9 


55 


37 


Percent Analgesic 










Doses 


62.6 


S4J) 


873 


89.2 



The generally accepted QQ»puurii«5m, mmg nW mis, is 
that morphine is 10 tonnes as potffinnt as itemDoralL al- 
though 10 mg of morphihnie prafrailMy giiwes nmsHre pn»- 
found analgesia than 100 nmg ran' <dkmmtHnn>IL. 

Survey of records from ow tawpitlaiD ptaimiiiaey ire- 
veals the following statistical irelaltaaMiHiJnnps tetwaam imor- 
phine and demerol. For tlkraaige ocfflnpinriiBim. ffigiicnfs 
were compiled on the analgesic oqpmvjifaiiitt «sff 11(0) mrag of 
morphine = 100 mg of denwmafL, 

1. In the multiple dose wialk. dkunnanofl omMs atinDmt 
twice as much as morphine C$ft.ffir5 par <t$me vs. 2%# 
per dose). 

2. In the Tubes the same raSra> its ffiminnadl ((2Dc for 
demerol vs. 124 for morphine). 

3. On the general surgical serwkss ftWamdls T-12, 
8-C and 4-Ct VA times unrane afcramemaO is uirsedl than 
morphine. 

4. In the recovery room. mnKHrpfiniiime is nasal twice as 
frequently as demerol. 

5. Considering all surgical sareisaes. nBanmnroill and! mnor- 
phine usage is about equal. 

A review of the concepts amdl dteaanatiejiistiics off pain 
has been presented as a fljadtgrcwiuimdl inmr itflac dftsaJHSMsm 
of postoperative pain relief, in smimmmiairf, mat all post- 
operative patients have paia. ¥w tritasc wto «to. the 
amount of suffering relieved! wiffll dkywondj mm ttfte ana&eOQD— 
gent use of available drugs, gm«dl nnuiinaiimg came, mud a 
consideration of the psychologic unsafe rf Oft 



SNAIL INVESTIGATION CENTER FOR THE AMERICAS 

Under an agreement between the Brazilian Ministry 
of Health and the Pan American Sanitary Bureau, 
which acts as the WHO Regional Office for the Ameri- 
cas, a Schistosomiasis Snail Identification Center has 
been set up at the National Institute for Rural Endemic 
Diseases, Belo Horizonte, Brazil. 

The incidence of schistosomiasis or bilharziasis, un- 
like that of most communicable diseases, is increasing. 
It already affects some five million people in the 
Americas and is becoming an important health problem 
in a number of countries and territories, including 
Brazil, the Dominican Republic, Puerto Rico; St. Lucia. 



Surinam, Venezuela, and other CaurfihiKsani catmmtiries. 
In some tropical areas whole wflHagps atne affientoiL 

Research workers at the Center will iimwestliipiute how 
snails live, their breeding faofoilK, nine uHiwsirse* ttfaitt affect 
them, the birds and animniah tftaut pro man them, etc. 
Such research may eventually Head to nine eradication 
of bilharziasis from the Anrarkas and a tatter life for 
millions of people.— WHO CThnnraniikfle 1$((3)): 103. 
March 1964. 



CANCER IS NOT CONTAGIOUS 

Don't fear cancer: do somroctthiimg atountt StL. 

U. S. NAVY MEDICAL 1NIEWS LETTER 



MOBILE EMERGENCY CART FOR INTENSIVE CARE WARD 
U.S. NAVAL HOSPITAL, NEWPORT, RHODE ISLAND 



CAPT Alexander C. Hering MC USN, LT Gordon I. Goldstein MC USNR, LCDR 
Doris M. Sterner NC USN. 



An intensive care ward functions well when there is 
a minimum of confusion and a maximum of efficiency. 
Toward this end the idea of supplies-in-motion rather 
than peop!e-in-motion developed. 

A standard, wheeled dressing cart (Fig. 1) became 
available from on-board stocks when two examining 
rooms were combined. Hospital carpenters fabricated 
drawers and shelves of plywood, labelled in startling 



red and black, to fit accurately in the cart, (Fig. 2). The 
smaller shelf labels read: 

cardiac arrest tray 

adult tracheotomy tray 

pediatric tracheotomy tray 

cut-down tray 
LV. solutions, polyethylene catheters, antiseptic, 
"Amha" resuscitator and a chart showing closed chest 




FIGURE 



U. S. NAVY MEDICAL NEWS LETTER 




FIGURE 2 




FIGURE 3 



U. S. NAVY MEDICAL NEWS LETTER 



resuscitation are positioned on the top surface of the 
cart. The sterile trays are enclosed in heavy plastic 
bags, which obviates the necessity of frequent resteriliza- 
tion. Tests have shown the trays to be sterile six 
months or longer. These plastic bags (originally new 
linen wrappings) were contributed by the hospital linen 
room civilian supervisor, and were the subject of a 
Beneficial Suggestion. 

The AIRWAYS drawer contains oropharyngeal air- 
ways, laryngoscopes (infant and adult), endotracheal 
tubes, (infant and adult), mouth-to-mouth plastic arti- 
ficial respiration airways, nasopharyngeal packs and Fox 
balloons. 

The TUBE ADAPTERS drawer contains a set of 
labelled multi-colored plastic connectors, as well as ap- 
propriate metal and crimped rubber fittings, for ready 
attachment of resuscitative or positive-pressure devices 
to endotracheal tubes or tracheostomy tubes. 

IV. SUPPLIES drawer contains needles, tubing sets, 
tourniquets, alcohol sponges, syringes. 

The DRUGS drawer (Fig. 3) contains the following 
sterile vials and ampules: 



sodium bicarbonate 

50% dextrose 

sodium pentothal 

sodium amytal 

xylocaine 

saline and water for 

injection 
Wyamine 
Solu-cortef and Solu- 

Medrol 



hydrocortisone 

aminophyliine 

neosynephrine 

adrenalin 

Cedilanid 

atropine 

pronestyl 

calcium chloride 

lsuprel 

quinidine 



Certain theoretical advantages of such a cart were 
augmented by practical advantages which showed them- 
selves over the ensuing 12 months: 

1. Centralization of emergency supplies in a small, 
compact unit freed a space occupied by a large, 
cumbersome stock shelf. 

2. The use of plastic bags lightened the re-sterilization 
chore in the Intensive Care Ward and further dem- 
onstrated the concept of prolonged sterile pack- 
aging. 

3. The well-labelled mobile cart, always located in the 
same place near the nurse's station, provided a con- 
versation piece for the ward staff and became a 
practical teaching aid for corpsmen, nurses, and 
doctors. 

Acknowledgements 

LCDR Doris M. Sterner NC USN*, the Intensive 
Care Ward Supervisor is shown in Fig. 1 at the helm 
of the USS LAST CHANCE. HM3 Bennie Trent, also 
shown in Fig. 1, was at the time Enlisted-Man-of-the- 
Month as a result of his fine performance of duty on 
the Intensive Care Ward. 

The contents of the DRUGS drawer resulted from 
combined suggestions from the Departments of Medi- 
cine, Surgery, and Anesthesiology. 



• Currently assigned to BUMED on TAD from BUPERS. 

Reference 

Haynes. Lewis L., CAPT MC USN and Harrington, Phyllis, LCDR 
NC USNR. Three Years' Experience With Intensive Treatment 
anil Recovery Unit in Medicine and Surgery. Military Medicine 
125: 398-402, June I960. 



FROM THE NOTE BOOK 



SUMMARY OF RECENT CHANGES 
IN MEDICAL TRAINING PROGRAMS 

1. Ensigns (1915) (students in medical school) can 
now apply for the Senior Medical Student Program and 
the Naval Intern Program by mail. They are no longer 
required to visit recruiting stations in person for inter- 
views or for physical examinations. Application kits 
are mailed to the students from BuMed. 

2. Students in the Senior Medical Student Program 
now receive the full pay and allowances of an Ensign 
during the entire senior year, providing they remain 
engaged in school approved elective work. Previously, 
students who took elective work in lieu of vacation 



were placed on leave, or leave without pay, during such 
periods. 

3. The intern watch schedule in all naval training hos- 
pitals has been changed for weekdays and weekends to 
one out of three or better. With more free time interns 
will have greater opportunities to pursue the academic 
aspects of their training. 

4. Navy residents are now offered the opportunity to 
request retention at their naval hospitals for an addi- 
tional year after training, in order to better prepare for 
their American Board examinations. This opportunity 
is offered where no practice time is required to qualify 
for the examination. Favorable consideration will be 
given to such requests, depending upon the demands of 
the service. — Medical Corps Branch. Professional Di- 
vision, BuMed. 



U. S. NAVY MEDICAL NEWS LETTER 



THREE NAVY DOCTORS WIN AWARDS AT 
ARMED FORCES OB-GYN SEMINAR 

The Thirteenth Annual Armed Forces Seminar on 
Obstetrics and Gynecology, held at Andrews Air Force 
Base 26-29 October 1964, was a well-attended, re- 
sounding success. The host service, the United Slates 
Air Force Medical Corps, is to be thanked and con- 
gratulated. Three prizes awarded at this seminar were 
won by doctors in the United States Navy Medical 
Corps. 

The Robert A. Kimbrough Award for the best resi- 
dent paper of the meeting was given to LCDR A. C. 
Rolen MC USN. United States Naval Hospital. Oak- 
land, California, for his paper on the "Rudimentary 
Uterine Horn, Obstetrical and Gynecological Implica- 
tions." The Host Award for the paper originating from 
work carried out in a small hospital without a teaching 
service was won by LCDR Istvan Nyirjesy MC USN, 
United States Naval Station Hospital. Naples, for his 
paper on "Obstetrical Factors in Mental Development." 
Both the X-ray Contest and an Endocrinology Contest, 
conducted during the meeting, were won by LT Thomas 
C. Rowland MC USN, United States Naval Hospital, 
Bethesda. Md., where he is a third year OB-GYN Resi- 
dent.— From: CAPT D. M. Shook MC USN. Head 
of Training Branch. Professional Division, BUMED. 

DR. KAZMIERSK1 FIRST WOMAN 
OPTOMETRY OFFICER IN THE NAVY 

Anne P. Kazmierski, O. D., a June 1964 graduate of 
the Massachusetts College of Optometry, valedictorian 
of her class, has accepted an appointment as Ensign. 
Medical Service Corps, USNR |W). Dr. Kazmierski is 
the first woman optometry ollicer in the Navy and has 
already reported to the U. S. Naval Base, Newport, 
Rhode Island, for Indoctrination Training. Upon com- 
pletion of the course at Newport, Dr. Kazmierski will 
receive further indoctrination at the U. S. Naval Hos- 
pital. Bethesda, Md., before reporting to her assigned 
duty station at the U. S. Naval Hospital. Oakland, Cali- 
fornia. 

HOSPITAL CORPSMEN DEMONSTRATE 
VALUE OF "INTENSIVE CARE" TRAINING 

On 23 September 1964, William C. Cato, Storekeeper 
Second Class, attached to the destroyer USS MYLES 
C. FOX. was admitted to the Boston City Hospital for 



a severely crushed chest and twelve broken ribs, fol- 
lowing an automobile accident. He was placed on the 
Danger List and required the use of suction apparatus, 
respirator, and an emergency tracheotomy to permit 
adequate breathing. His condition precluded movement 
to the nearby Chelsea Naval Hospital for thirteen days. 
The attending physician recommended 24 hour nursing 
coverage and asked if the Navy could provide this due 
to the shortage of nurses. Chelsea Naval Hospital could 
not provide nurses, hut did send three Hospital Corps- 
men specially trained in intensive care. The Command- 
ing Officer of this hospital was notified and a 24 hour 
medical watch by three Hospital Corpsmen from his 
Staff was commenced. 

The corpsmen were transported from the Chelsea 
Naval Hospital to the Boston City Hospital and were 
returned after a watch period of approximately ten 
days. 

SK2 CATO is now a patient at Chelsea Naval Hos- 
pital and improving steadily, although still on the Seri- 
ous List (as of this writing). The Administrative Super- 
visor of the Dowling Building, Boston City Hospital, 
expressed gratitude for the competence of these Corps- 
men and the professional manner in which they cared 
for their patient at all times. 

In performing this 24 hour coverage with nursing 
care. Jay A. Decatur, Hospitalman, USN; James J. 
Merryweather, Jr., Hospitalman, USN; and Leopold F. 
Sitnik, Jr.. Hospitalman, USN, demonstrated the time 
honored tradition that the "NAVY TAKES CARE OF 
ITS OWN".— Submitted by CAPT L. L. Isert MSC 
USN, Administrative Officer, USNH, Chelsea, Mass. 

AMERICAN BOARD CERTIFICATIONS 

American Board of Obstetrics and Gynecology 
LCDR James A. Austin MC USN 
LCDR John D. Manhart MC USN 

American Board of Pediatrics 

LCDR Richard L. Rogers MC USN 

American Board of Preventive Medicine 

LCDR Charles E. Alexander. Jr. MC USN 

American Board of Surgery 

LCDR Francis E. Banich MC USNR 
LCDR John Richard Campbell MC USNR 
LCDR Joseph T Mullen MC USN 
LCDR William J. Storz MC USNR 



COST OF CANCER 

Each year cancer deprives the national economy of 
50,000 man-years of productivity. Since cancer often 
strikes in the later years, many of its victims are highly 
trained, skilled personnel. The dollar loss is inestimable. 
The annual hospital bill for cancer is estimated to be 
over $400,000,000. 



CANCER SELDOM CAUSES PAIN IN THE EARLY STAGES 

In nearly every cancer case there is a time when the 
cancer, if it is detected, may he cured. This is usually 
the "silent stage", 



8 



U. S. NAVY MEDICAL NEWS LETTER 



A Look at Our U.S. Naval Hospitals- 
Bremerton, Washington* 



(Third in a Series) 



This Naval Hospital is the only one in the Thirteenth 
Naval District. It occupies 25 acres of land, situated 
on the north central edge and within the confines of 
the Puget Sound Naval Shipyard, overlooking the 
Shipyard and Sinclair Inlet. The Shipyard adjoins the 
City of Bremerton. 

The principal buildings of the hospital are of old 
English Colonial architecture, of brick, and masonry 
construction, in a setting of spacious lawns, flower 
gardens, and tall fir trees. From the hospital grounds 
may be seen the snowcapped Olympics and other 
scenery of beauty. 

The site for the Shipyard was purchased in 1891 
and on September 16 of that year the "Puget Sound 
Naval Station" was established. The first Medical Depart- 
ment activity of the station was quartered in the USS 
NIPSIC. a small gun boat. On 4 November 1901, the 
Medical Department activities were transferred from 
the NIPSIC to a frame building ashore. On 25 January 
1903, these sick quarters were designated by the Sec- 
retary of the Navy as a Naval Hospital. This marked 
the commissioning of the first naval hospital in the 
Northwest area, 

During the year 1905, talk of a new hospital had 
begun and the present site had been selected. Money 
was appropriated by Congress and plans for the new 
hospital were completed in 1907. The contract for con- 
struction of the hospital, at a cost of $143,971, was 
awarded 29 May 1909. The specifications provided for 
three buildings: a three-story and basement administra- 
tion building: a two-story and basement subsistence 
building: and a two-story and basement ward building; 
all to be connected by solaria. 

These buildings, which today constitute the hospital 
proper, were completed on 27 January 1911; however. 
as no appropriation had been made for equipment for 
the hospital at that time, it was not until 1 January 
1912 that the new hospital was occupied. 

On 8 November 1920, the Recreation Building, which 
was constructed by the American Red Cross, was com- 



* Submitted hy CAPT J. E. Gorman, MC USN, Commanding 
Officer. 



pleted; and it was turned over to the hospital on 4 
December of that year. In June of 1920, the present 
WAVE Quarters was completed; but this building was 
designated originally as the "Nurses' Quarters." One 
wing in 1922 and another in 1923 were added to our 
permanent group of hospital buildings. 

In May 1923, ground was broken for a new brick 
two-story apartment house which was to contain four 
apartments for medical officers of the staff; and the 
foundation was laid in August 1923 for quarters for 
the Commanding Officer. During the year 1925, con- 
struction was begun on two sets of quarters designated 
as "Pharmacist Quarters." These seven sets of quarters 
are the same ones and the only ones the hospital has 
today. 

A plan for the further development of the hospital 
was proposed in 1928. It included construction of ad- 
ditional wings to the hospital group, a new Hospital 
Corps quarters, and a maintenance utility building 
which was to include space for a garage, machine shop, 
paint shop, electrical shop, and plumbing shop. The 
wing of the permanent group was started in 1931; the 
utility and garage building was constructed in 1936; 
the Hospital Corps Quarters was completed in 1937: 
and in 1939 the wing was added. 

On 7 December 1941. it was very apparent that the 
hospital must expand and, shortly thereafter, wartime 
construction began. In 1942, the Sick Officers' Quarters 
and a permanent wing were constructed. Also, three 
"temporary" ward buildings (now designated as Ward 
O, Ward P, and Dependents' Clinic) were completed. 
The laundry building was completed in 1944. 

During the war years, 1941 to 1945, a peak patient 
load of 1041 was reached on 21 August 1944. During 
the Korean Campaign, from June 1950 to July 1951, 
there were over 17,000 admissions to the hospital with 
amost a half million patient days; and the authorized 
bed capacity varied from 750 to 375. Since then the 
authorized bed capacity has been reduced from 375 in 
1956 to 300 in 1958, 250 in 1959, 225 in 1960, 200 in 
1961, 175 in 1963. and 150 in 1964. 

Background data of the hospital would not be com- 
plete without some history of the City of Bremerton. 



U. S. NAVY MEDICAL NEWS LETTER 



*te 




U.S, NAVAL HOSPITAL—BREMERTON, WASHINGTON 

Official U. S, Navy Photograph. 



The people of Bremerton have always taken great in- 
terest in the Navy. They are highly conscious of de- 
pendence upon the civilian employees of the Shipyard 
and service personnel, on duty aboard ships and sta- 
tions in the area, for support of both business and 
Government. A large percentage of the residents are 
retired military and civil service personnel. 

Bremerton was platted in 1891 and named for the 
owner of the greater portion of the land, a Mr. Bremer. 
Early Bremerton had few stores, but many saloons and 
restaurants. It was familiarly known as "Mud Town." 
The growth of Bremerton was slow; and it was not 
until 1912 that the first streets were paved. In 1918 
and 1927, the City added considerably lo its area and 
population by annexations. But World War II caused 
a three-fold expansion in residential areas and business 
enterprises due to the influx of workers and servicemen; 
and the population reached 31.000. There has been 
a fluctuation since that time and the population at 
present is about 32.000. 

STAFFING 

The medical and dental officer staff includes special- 
ists qualified or certified in the following clinical fields: 



Internal Medicine 

Dermatology 

Neuropsychiatry 

General Surgery 

Anesthesiology 

Urology 

Orthopedics 



Ophthalmology 

Otolaryngology 

Oral Surgery 

Obstetrics & Gynecology 

Pediatrics 

Radiology 

Pathology 



In the para-medical area, our officer staff includes 
an optometrist, physiotherapist, pharmacist, and repre- 
sentatives of various nursing specialties and administra- 
tive fields, 

The nursing service includes both military and civilian 
personnel. 

The enlisted staff includes all the technicians neces- 
sary to support the specialists indicated above as well 
as the general duty hospital corpsmen. 

RECENT DEVELOPMENTS 

The pubic works functions of the U. S. Naval Hos- 
pital, Bremerton, were consolidated with those of the 
Puget Sound Naval Shipyard on I July 1963. An 
Emergency/ Service Work Center is maintained. 

A central dictating system of 19 stations with 4 
recorders was placed in operation in July of [963. 



10 



U. S. NAVY MEDICAL NEWS LETTER 



The inventory of the Professional Library has been 
expanded to include professional reading material and 
references for staff officers other than medical officers 
alone. 



The most recent improvement made was the installa- 
tion of a new 3! -station radio paging system. 



WORKLOAD DATA— FISCAL YEAR 1964 

Inpatients Peak census 165 

Admitted: Active duty 1178 
Dependents 1387 
Other 437 

Total ~~7~ 3002 

Surgical operations 1000 

Surgical procedures 3511 

Discharges 2997 

Average occupied beds 1 26.4 

Average length of patient stay 15.18 

Outpatients Active duty 21860 

Dependents 44892 
Other 13864 

Total - ~ 80616 

Immunizations 846 1 

Births 378 

Prescriptions Filled 

Inpatient 21955 

Outpatient 58781 

Total 80736 

Rations 

Served 74386 

Cost per ration $1.1278 



PHS CAMPAIGN AGAINST AEDES AEGYPTI 

The Public Health Service recently began a 5-year 
program to eliminate the yellow fever mosquito Aedes 
aegypti from the United States. Congress appropriated 
$3 million to support such efforts in fiscal year 1964. 

Aedes aegypti is present in Florida. Georgia, Ala- 
bama, South Carolina, Texas, Tennessee, Mississippi. 
Louisiana, Arkansas, Puerto Rico, and the Virgin 
Islands. Although the United States has not had an 
epidemic of yellow fever since 1905, the disease is 
present in parts of Central and South America, and in 
the Caribbean area there have been extensive outbreaks 
of dengue fever, which Aedes aegypti also carries. 

The eradication program administered by the Com- 
municable Disease Center in Atlanta, Ga., is part of an 
international endeavor to eliminate the mosquito from 
the Western Hemisphere. — Public Health Reports 
79(5): 391. May 1964. 



TRAINING COURSE FOR CHIEFS OF NATIONAL 
MALARIA SERVICES 



Fifteen senior officials from the malaria Services of 
countries in the WHO Western Pacific and Eastern 
Mediterranean Regions attended a special 10-day train- 
ing course in malaria epidemiology at the Malaria 
Eradication Training Centre in Manila in June 1964. 

Among the trainees were chiefs of malaria eradica- 
tion services in Korea, Laos, Sudan, and Viet-Nam. 
Other trainees came from China (Taiwan), Japan, 
Pakistan, the Philippines, and Sarawak, 

The Malaria Eradication Training Centre is a joint 
enterprise of the Government of the Republic of the 
Philippines, the U. S. Agency for International Develop- 
ment, and WHO.— WHO Chronicle 18(9): 358. Sep- 
tember 1964. 



U. S. NAVY MEDICAL NEWS LETTER 



11 




DENTAL SECTION 



EVALUATION OF DIRECT AND 
INDIRECT PULP CAPPING 

Roland R. Hawes, Joseph Dt'Maggio and Fayez Sayegh, 
Eastman Dental Dispensary, Rochester, New York, 
Jour Den Res 43(5)Part II: 807-808, Sept-Oct 1964. 

This report presents observations lasting from 2 weeks 
to 4 years of teeth treated by indirect pulp capping, 
direct pulp capping and pulpotomy. Teeth to be 
treated were assigned randomly to each treatment 
group after clinical examination indicated a deep carious 
lesion and a vital pulp. Teeth with symptoms sugges- 
tive of pulpitis were not included. Calcium hydrox- 
idemethyl cellulose paste was applied over pulp tissue 
or residual carious dentin, followed by a base of zinc 
phosphate cement or accelerated zinc oxide-eugenol 
and a permanent restoration in a single sitting. A total 
of 1,048 teeth have been treated, 475 by indirect pulp 
capping, 484 by direct capping, and 89 by pulpotomy. 
During the period of observation less than 3 per cent 
of indirect pulp cappings have resulted in frank clinical 
failures, whereas 7 per cent of direct pulp cappings and 
19 per cent of pulpotomies have resulted in such clinical 
failures. Radiographic evaluation reveals significantly 
higher incidence of periradicular radiolucence and ab- 
normal primary root resorption in all treatment groups 
hut does not significantly reduce the advantage in favor 
of indirect pulp capping. This is believed valid even 
when 25 per cent ot the successful indirect pulp cap- 
pings are disallowed because it is probable that only 75 
per cent of these treatments were done on teeth with 
exposures. Histological study of 314 teeth, 105 after 
indirect and 180 after direct pulp capping, and 29 
after pulpotomy also indicated a higher failure rate than 
was indicated by clinical and radiographic examination 
in all groups. However, these observations do not 
significantly reduce the advantage of the indirect pulp- 
capping procedure. Simple bacteriological culturing of 
dentinal scrapings from selected teeth, reopened at 
varying times after treatment, suggests the persistence 
of cultivable organisms for prolonged intervals follow- 
ing both types of pulp treatment. 

Editors note: This article brings strong confirmation 
to the policy of the Chief of the Dental Division, Bureau 
of Medicine and Surgery, published in U. S, Navy 
Medical News Letter 43(12): 22, June 19. 1964. 



THE ORAL TISSUES RESPONSE TO 
ULTRASONIC INSTRUMENTATION 

CDR G. H. Green DC USN and LCDR A. D. Sander- 
son DC USN. NDS Special Report No. 1, Oct 1964. 

This report consists of a thorough review of the pub- 
lished literature on the use of ultrasonic instrumentation 
in peridontal applications. The authors report that al- 
though no significant biological changes in bumans, 
monkeys, or dogs have been reported when dental 
ultrasonic techniques were applied in the manner cur- 
rently in clinical use, numerous investigators have dem- 
onstrated that severe, irreversible tissue damage can 
occur if considerable care and skill are not exercised. 
However, the same findings are also applicable to the 
use of the more conventional rotary dental instruments. 
The application of constant hard pressure, for instance, 
will result in tissue damage whether the application is 
by means of the ultrasonic instrument or of low-speed 
rotary instruments. Tissue damage will also occur with 
either ultrasonic or high-speed rotarv instruments if a 
water coolant is not properly used. The damage result- 
ing from ultrasonic procedures is considered to be from 
the effects of frictional and absorbed heat rather than 
from any mysterious energy produced by ultrasound. 

Based on this evidence, the authors concluded that 
the ultrasonic unit is an excellent adjunct to periodontal 
therapy in that it provides more rapid and efficient 
removal of gross deposits of calculus than can be at- 
tained with hand instruments. The evidence would also 
indicate that this equipment could safely be used for 
the more rapid removal of supragingival calculus, not 
only by properly trained dentists, but also by carefully 
trained and supervised auxiliary personnel. 

THERMAL CONDUCTIVITY OF 

RESTORATIVE MATERIALS AND 

CAVITY LINERS 

Hollenhack, George M. and Sullivan, Maxwell. 5255 
Encino Ave., Encirto, Calif., Jour South Calif Den 
Assoc 32: 208-213 July 1964. Dental Abstracts 9(10): 
632 October 1964. 

For years dentists have used various types of cavity 
liners and restorative materials in the belief that they 
had thermal insulative qualities that would protect the 



12 



U. S. NAVY MEDICAL NEWS LETTER 



pulp against overstimulation caused by temperature 
changes. Although clinical experience indicates that 
such cavity liners and materials do protect the pulp 
from various types of stimuli, tests of seven restorative 
materials and a dental varnish show that the thermal 
insulative properties of some materials are less than 
commonly believed. 

A number of special instruments were designed to 
ascertain the thermal conductivity of dental varnish, 
whale dentin, zinc phosphate cement, zinc phosphate 
cement plus 50 per cent (by weight) alloy fillings, zinc 
oxide-eugenol, silicate cement, self-curing acrylic resin, 
cast gold and amalgam. The apparatus included two 
water baths, a pyrometer and thermocouple, and an 
instrument which permitted all specimens to be made 
in the same dimension with a tubular cavity in the 
center of each specimen. 

The best thermal insulator of all materials tested 
was whale dentin. The next best thermal insulator 
was self-curing acrylic resin; however, probably the 
deleterious properties of this material would preclude 
its use as a thermal insulative material. 

Dental varnish — even when used in six coats — does 
not seem to possess any significant thermal insulative 
properties. 

Of two amalgam specimens, the specimen with all 
possible excess mercury expressed before condensation 
had appreciably less conductivity (that is, greater ther- 
mal insulative value) than the amalgam specimen pre- 
pared to a 50:50 ratio of mercury and alloy without 
mercury expressed. 

The addition of alloy filings to the zinc phosphate 
cement slightly increased the thermal insulative proper- 
lies of the cement. 

Cast gold had twice the insulative value of 1:1 ratio 
amalgam. Self-curing acrylic resin had twice the in- 
sulative value of cast gold. 

Editor's comment: There is risk here that a hasty 
reader might conclude that use of cavity liners is un- 
important. To the contrary, with modern high-speed 
cutting including adequate air-water spray, the use of 
a varnish to seal the freshly cut dentinal tubules is 
highly important. (Stanley, H. R. JADA 63: 749-766. 
1961). 

OBJECTIVES OF DENTAL EDUCATION 

Jour Den Education 27(3): 206-207 September 1964. 

The Committee on Curriculum of the American As- 
sociation of Dental Schools developed the following 
statement on the objectives of dental education. These 
objectives are reprinted in the News Letter to obtain a 
wider reading audience in order to stimulate efforts by 
all dental officers toward a total accomplishment of 
these goals. 

The colleges, faculties, and schools of dentistry of 
the United States and Canada are integral parts of 



great university complexes which have as one of their 
major objectives the education of men and women for 
careers in all of the health services in order best to 
meet the national need. 

Dentistry, while traditionally maintaining its strong 
orientation to medicine and the other health sciences, 
has an autonomous system of education whose profes- 
sional standards are essentially derived from policies 
established by the organized dental profession. 

Dental education has strong roots in the basic sci- 
ences, and dental teaching is continually enriched by 
the services of many persons from other health and 
scientific disciplines. Dental education is also premised 
on an awareness of the national culture and its heritage. 
Thus, by this combination, dental education strives 
to give its graduate an understanding of the totality of 
human health and personality which will enable him 
to fulfill usefully his own career in dentistry. 

Dental education recognizes its responsibility in pro- 
viding a sufficient number of educated persons so as 
to guarantee the maximum levels of dental health serv- 
ice which are consistent with the philosophy and re- 
sources of the country and all of its citizens. Dental 
education believes in the right of all persons to receive 
competent health service and. in the national tradition, 
the ultimate objective must be to make all health service, 
including dental health care, an essential and desired 
part of the national standard of living. These challenges 
of man and society to the dental profession can be 
met only by continuing achievement and renewal of 
the following objectives of dental education: 

1 . To select students from all walks of life who are 
intellectually, morally, and physically qualified for a 
career of service to the public in dentistry. 

2. To provide an academic environment for these 
students which will stimulate and enlarge both their 
appreciation and understanding of the philosophic, 
social, and intellectual problems of the day. 

3. To instill in them the knowledge of the arts and 
sciences which will enable them to practice dentistry 
so as to provide a competent service to the public and 
lifelong satisfaction to themselves. 

4. To emphasize the orientation of the dental student 
to the physical and biological sciences which the practice 
of modern dentistry involves. 

5. To provide the clinical training and experience 
which are essentia] in the provision of a competent oral 
health service to the patient, 

6. To foster knowledge of the value, design, and 
methodology of dental education so that the dentist may 
evaluate research findings and apply them rapidly and 
competently in his own practice. 

7. To educate auxiliary personnel for the dental pro- 
fession so that they will be competent in the discharge 
of the duties which are delegated to them by the den- 
tist and which are carried out under his direction, thus 



U. S. NAVY MEDICAL NEWS LETTER 



13 



enlarging the dentist's capacity to render an efficient 
oral health service. 

8. To offer graduate and postgraduate educational 
programs in the basic, dental, and clinical sciences as 
a means for enlarging the general competence of the 
dentist in all fields of practice and for providing the 
advanced education and clinical experience which are 
the essential basis for the limitation of practice to den- 
tistry. 

9. To make conformance to the letter and spirit of 
the principles of ethics an unquestioned part of pro- 
fessional life. 

10. To insure that teaching is frequently renewed 



with new ideas, methods, and personalities to the end 
that it meets the changing needs of the student and of 
the society in which he will live and serve. 

1 1. To enlarge the horizon of particularly well-quali- 
fied students so that they will scan the possibility of 
future careers in dental research, education, administra- 
tion, and dental public health. 

12. To develop the potentialities of the dental gradu- 
ate for leadership in his profession and his community. 

13. To bring conviction to every dental graduate that 
his dental education will serve him well only so long as 
he refreshes and renews it through lifelong, continuing 
education. 



PERSONNEL AND PROFESSIONAL NOTES 



Reason's 05reetmgs 



There are many ways to observe the anniversary of 
Christ's birth and the beginning of the New Year. In 
whatever manner you celebrate this season, I hope this 
one will be the most meaningful and joyful yet. There 
is a word in the Greek language, "agape", which means 
all that is exemplified by the brotherly love and warmth 
for fellow man which come to each individual during 
this season. Every year, when this "'agape" spirit makes 
each greeting a joy, I hope for a continuation of that 
deep feeling throughout the year. Let us make this 
our resolution for the coming year. 

I wish you a very Merry Christmas and a Happy 
New Year! 

F. M. KYES 

Rear Admiral, DC. USN 

Naval Research Croup Studies Low Temperature Phos- 
phorescence of Calcified Tissue. CDR Kirk C. Hoerman 
DC USN, Dental Department, Naval Medical Re- 
search Institute, National Naval Medical Center, 
Bethesda, Maryland, delivered a paper, "Afterglow of 



Proteins in Non-Aqueous Media," at the 14th Annual 
Instrument Symposium and Research Equipment Ex- 
hibit, Clinical Center Auditorium, National Institutes 
of Health, Bethesda, Maryland, October 7, 1964. 

In a BuMed sponsored research subtask on the or- 
ganic components of enamel and dentin, CDR Hoer- 
man is using fluoromicrophotometry for quantitative 
fluorescence and phosphorescence analyses of hereto- 
fore obscure protein molecules of especially low solu- 
bility. Collaborating with CDR Hoerman in this re- 
search are Miss S. A. Mancewicz and Mr. A. Balekjian, 
who are Research Associates of the American Dental 
Association, and are at the Naval Medical Research 
Institute in the capacity of Guest Scientists. Further 
information on this work may be found in "Phosphor- 
escence of Calcified Tissue," by Hoerman, K. C. and 
Mancewicz. S. A., Arch Oral Biol, August 1964. 

Navy Dental Corps Participation at ADA Convention. 
The following U. S. Navy Dental Corps contributions 
were made to the 105th Annual Session of the Ameri- 
can Dental Association held in San Francisco, Cali- 
fornia, 9-12 November 1964. 



VIDEO TAPES FOR CLOSED CIRCUIT TELEVISION 



RADM F. M. KYES DC USN 
Chief, Dental Division BuMed 

CAPT. H. W. LYON DC USN 
NMRI NNMC Bethesda, Maryland 



Mass Application of Stannous Fluoride 
Cariostasis in Naval Personnel 

Factors Affecting Healing of 
Extraction Defects 



14 



U. S. NAVY MEDICAL NEWS LETTER 



CAPT G. H. ROVELSTAD DC USN 
NDS NNMC Bethesda, Maryland 

CAPT F. G. GROSSMAN DC USN 
NDS NNMC Bethesda, Maryland 

CDR K. C. HOERMAN DC USN 
NMRI NNMC Bethesda, Maryland 

LCDR J. S. LINDSAY DC USN 
NDS NNMC Bethesda, Maryland 

LCDR W. R, COTTON DC USN 
NMRI NNMC Bethesda, Maryland 



Need for Clinical Research 



Preventive Dentistry 



Protective Qualities of Maximal-Stimulated Saliva 



Emergencies in the Dental Office 



Application of Radioisotopes in Pulp Studies 



LCDR J. F. HARDIN DC USN 
Naval Hospital, Oakland, California 

LT K. L. COTTLE DC USN 
NavDept Dispensary Wash., D,C. 



TABLE CLINICS 

Mucogingival Surgery 



Temporary Acrylic Bridge and Inlay Technic 



CAPT A. R. FRECHETTE DC USN 
CO USNDS NNMC Bethesda, Md, 



PANEL MODERATOR 

Immediate Dentures 



ESSAYS 



CAPT A. R. FRECHETTE DC USN 
CO USNDS NNMC Bethesda. Md. 

CAPT F. L. LOSEE DC USN 

NavTraCtr Great Lakes, 111. 

CAPT F, J. KRATOCHVIL DC USN 

NDS NNMC Bethesda, Md. 

CAPT P. C. ALEXANDER DC USN 
NDC Long Beach, California 



Local Anesthesia in Dentistry 
Monitored hy: 



Complete Denture Stability as Related to Tooth 
Form and Position 

Geographic Distribution of Caries, Cancer and 
Coronary Disease 

A Complete Denture Technic for 
Selecting and Setting-up Teeth 

The Periodontium and the Cuspid Protected 
Occlusion 



SCIENTIFIC EXHIBIT 



CAPTS. S. E. TANDE DC USN and 

J. B. LEPLEY DC USN 

NDS. NNMC, Bethesda, Maryland 



MOTION PICTURE FILM FESTIVAL PANELIST 

CAPT S. E. TANDE DC USN, NDS, NNMC, Bethesda, Maryland 
U.S. NAVY DENTAL TRAINING FILMS (PREMIER SHOWING) 

MN-9727 Peridonta! Disease: Prevention and Early Treatment 

MN-9739 Immediate Denture Service: Coordinated Management 

MN-9868 Preventive Dentistry: The Prevention of Oral Disease 

MN-9773 Surgical Endodontics 

MN-9774 Intraoral Roentgenography: Improved Equipment and Techniques 

RADM E. G. F. POLLARD DC USN, Director Dental Activities, FIFTH Naval District, served as Delegate and 
CAPT J. J. DEMPSEY DC USN. TWELFTH Naval District Dental Officer, as Alternate to the ADA House 
of Delegates. 



U. S. NAVY MEDICAL NEWS LETTER 



15 



The following dental officers attended the indicated Reference Committee Hearings: 

CAPT D. C. MAXFIELD DC USN Dental Trade and Laboratory Relations 

NavSta San Francisco, California 



CAPT R. A. MIDDLETON DC USN 

NavHosp Oakland. California 

CAPT F. I. GONZALEZ JR DC USN 

NAS Alameda, California 

CAPT A. R. FRECHETTE DC USN 
CO NDS NNMC, Bethesda, Maryland 

CAPT M. E. SIMPSON DC USN 
NSYD San Francisco, California 

CAPT M. A. MAZZARELLA DC USN 
MedResUnit 1 Univ. (Oakland) Calif. 



Hospital Dental Service 



Public Health 



Dental Education 



Federal Dental Services 



Dental Research and Therapeutics 



Navy Dental Officers Participate in Periodontal Meeting. 
Three Navy dental officers from the National Naval 
Medical Center, Bethesda, Maryland, participated in 
the Fiftieth Annual Meeting of the American Academy 
of Periodontology held in San Francisco, California, 
4-7 November 1964. CAPT H. W. Lyon DC USN, 
NMRI, presented an essay entitled "Influence of Bone 
Marrow Implants." Captains T. R. Hunley and F. J. 
Kratochvil DC USN, NDS, presented a clinic on Sup- 
porting the Treatment of Advanced Periodontal Disease. 



Navy Presentation Before International Dental Society. 
CDR G. H. Green DC USN, NDS, NNMC. Bethesda. 
Maryland, served as panelist for a conference on Kera- 
totic Lesions of the Oral Mucous Membrane before 
the Second Annual Conference of the International 
Academy of Oral Pathology held in San Francisco, 
California 7-9 November 1964. He also monitored 
an exhibit entitled "Exhibit on Tongue Lesions" which 
was prepared by CAPT H. H. Scofield DC USN. LT 
COL J. Corny n DC USAF, and CDR Green at the 
Armed Forces Institute of Pathology, Washington, D.C. 



Navy Participation in Conference on Military Dentistry. 
CAPT V. J. Niiranen DC USN, Staff Dental Officer, 
Commandant, U. S. Marine Corps, served as Pro- 
gram Chairman for the Maxillofacial Meeting of the 
International Conference on Military Dentistry held 
in San Francisco, California, 7-14 November 1964. 
CAPT J. B. Lepley DC USN, NDS, NNMC, Bethesda, 
Maryland, presented an essay entitled "Special Pros- 
theses and Materia! in Support of Medical Specialties," 
The conference was sponsored by the Armed Forces 
Dental Services Commission of the Federation Dentaire 
Internationale. 



Dental Service Report, DD Form 477— 1 . Responsible 
dental officers are reminded that the Dental Service 
Report. DD Form 477-1, Equipment and Facilities 
Supplement, shall be submitted on 1 January each year 
in accordance with MANMED Art. 6-151. The original 
shall be addressed to BUMED (Code 612), one copy 
to the Field Branch BUMED, 3rd Ave. and 29th 
Street, Brooklyn, New York 11232, and one copy 
(unless otherwise directed) to the reviewing officer. 



Navv Dentist Receives Award for Professional Paper. 
CAPT P. J. Boyne DC USN. USS BON HOMME 
RICHARD, was awarded a prize recently for a pro- 
fessional paper by the American Society of Oral Sur- 
geons. The award was made at the Annual Session of 
the society held in Las Vegas, Nevada 3-7 Nov 1964. 



Naval Dental Officer is Guest Speaker at Meeting of the 
Guam Dental Society. LCDR D. M. Grove DC USN. 
U. S. Naval Dental Clinic, Guam, M. I., recently pre- 
sented an illustrated lecture entitled "Full Denture 
Techniques" before the Guam Dental Society at Ander- 
son Air Force Base. The Society is a joint study club 
consisting of all military and most civilian dentists on 
Guam. Its purpose is to further professional knowledge 
by regular appearances of guest clinicians. Dr. Grove 
was elected President of the Society last July. Other 
elected officials include: CAPT Foreman KAN DC 
USAF, Secretary-Treasurer and LT O. B. Walker DC 
USN, U. S. Naval Dental Clinic. Guam, M. I„ Program 
Chairman. 



Naval Reserve Dental Officers Meet. CAPT R. F. Tuck 
DC USNR. Head, Dental Reserve Branch, BUMED. 



U. S. NAVY MEDICAL NEWS LETTER 



served as Presiding Officer for the Naval Military 
Seminar held in San Francisco, California, 9 November 
1964. RADM J. McN. Taylor USN, Commander 
Western Sea Frontier and Commandant TWELFTH 
Naval District, presented a talk titled "A Look at the 
World Situation Today." CAPT F. G. Grossman DC 
USN NDS, NNMC, Bethesda. Maryland, presented a 
paper on "The Naval Dental Corps' Preventive Den- 
tistry Program." The film. Intraoral Roentgenography 
— Improved Equipment and Technique was shown 
during the meeting. 



Naval Dental Reserve Selection Board Commencing 
Dates. 5 January 1965 — Flag Selection Board will act 
as continuation board for Captains, as there are no 
vacancies in Flag Billets at this time; 2 March 1965 — 
Selection Boards meet for selection to the rank of Cap- 
tain and Commander from their respective eligible 
fields; 20 April 1965 — Selection Board meets for selec- 
tion to the rank of Lieutenant Commander from Lieu- 
tenants eligible for selection. 



DENTAL TECHNICIANS SELECTED FOR PROMOTION 

Congratulations to the following dental enisted personnel upon their selection for promotion: 

Ensign MSC (Supply and Administration) USN 



Francis S. Connors (DTI) 
Jerry D. Galbreath (DTI) 



M. B. Quinn 
J. A. Pogas 



V. Blair 
W. W. Lee 
A. R. Howell 
R. L. Shell 
W. R. Sickles 
P. M. West 



F. B. Grisson 
J. P. Turan 
J. J. Mulligan 
C. W. Farthing 



C. W. Finley 

D. A. Johnson 



NavDentClinic Brooklyn, New York 
COMNINE Great Lakes, Illinois 

Advancement to DTCM Effective 16 November 1964 

USS Coral Sea 

SUBBASE New London, Connecticut 

Advancement to DTCS Effective 16 November 1964 

NavSta Charleston, South Carolina 

NavExamCtr Great Lakes, Illinois 

NDC Pearl Harbor, Hawaii 

2nd MarDiv FMFLANT 

NDC Washington, D. C. 

NDS NNMC Bethesda, Maryland 

Advancement to DTCA Effective 16 November 1964 

Naval Air Station Corpus Christi, Texas 
Naval Air Station Olathe, Kansas 
Naval Training Station Great Lakes, 111. 
Marine Corps Air Station Cherry Point. N. C. 

Advancement to DTCA Effective 16 January 1965 

NavMedResInst NNMC Bethesda, Maryland 
Marine Corps Recruit Depot San Diego, Calif. 



THE TEST THAT SAVES WOMEN'S LIVES 

The "Pap" (short for Papanicolaoa) smear, a pain- 
less, inexpensive cancer test done in the physician's 
office, is one of the most sensitive and reliable weapons 
in the arsenal of modern medicine for detecting cancer 
of the uterus at a time when it is most curable. Yet 
about 70 per cent of the American adult female popu- 
lation have never had this test, and 40 per cent have 
never even heard of it. Have you? 



CANCER KNOWS NO BOUNDARIES 

"Cancer is not American, or British, or Russian, or 
African. It is international, worldwide, lawless, fence- 
less. Fighting it must be the common concern of all 
mankind . . . Cancer is not bothered by passports or 
petty politics. It can find a billet in any home, any- 
where." 

— Dr.Harry M. Nelson, Past President 
American Cancer Society 



U. S. NAVY MEDICAL NEWS LETTER 



17 



AVIATION MEDICINE SECTION 



MEDICAL ASPECTS OF SPACE FLIGHT* 



By Captain Frank B. Voris MC USN, National Aeronautics and Space Administration 
Publication. U. S. Government Printing Office, Washington, D.C., 20402. 



About the author: 

Capt. Frank B. Voris, USN, at the time he wrote 
this article, was Chief of Human Research in the Bio- 
technology and Human Research Division of NASA's 
Office of Advanced Research and Technology. 

He received his Doctor of Medicine degree from the 
University of Illinois and served as resident surgeon 
at the St. Francis Hospital, Miami Beach, Fla. From 
1937 to 1941 he was engaged in private surgical prac- 
tice at Miami Beach. 

In September 1941 he was called to active duty in 
the Medical Corps of the U. S. Navy. In July 1942, 
upon completion of a course in aviation medicine at 
Pensacola, Fla., he was designated a navai flight sur- 
geon. In 1947, upon completion of flight training, he 
was qualified as a naval aviator. He was promoted to 
the rank of captain in July 1955. 

Captain Voris has served as head of the Special Ac- 
tivities Branch of the Aerospace Medical Association, 
and in I960 was Vice President for Aviation Medicine 
of the American College of Preventive Medicine. 

In 1952 he was awarded the Founder's Medal of the 
Association of Military Surgeons of the United States; 
and in September 1962 he received from the American 
Medical Association a Special Aerospace Medicine 



Honor Citation for service to the Nation and to medi- 
cine in the successful orbital flights of the American 
astronauts. 




Frank B. Vori<, M. D. 

Chief. Human Research 

Biotechnology and Human Research Division 

Office of Advanced Research and Technology. 

NASA*. 



MANNED SPACE FLIGHT 

NASA's manned space flight program includes Proj- 
ects Mercury, Gemini and Apollo, in that order — and 
with increasingly complex medical aspects to come in 
future long-range (lights. 

Project Mercury was primarily an engineering ex- 
ercise. For flights up to three orbits it was a fully 
automatic system, flown to test aerodynamics theory 



and numerous engineered subsystems, including those 
designed to support a man in space. The testing of 
man and his ability was a secondary aim of these flights. 
In passing from three-orbit flights to the six and one- 
half orbits of Waller Schirra and the 22 orbits of Gor- 
don Cooper, we went beyond the original engineering 
test concept to a man-machine combination test mis- 
sion. To extend Project Mercury flights beyond three 



* The original brochure contains ei^hc photographs illustrating 
essential items in the text, and is for sale by the Superintendent 
of Documents, U. S. (iovernment Printing Office. Washington. D. C. 
2(1402 — Price 15 cents. It is highly recommended. — Editor 



* Now assigned to duty in [he Bureau of Medicine and Surgery in 
the Research Development and Astronautical Sections of the Re- 
st ir'h Division, and as Director of the Astronautu.il Division of 
BUMED. 



18 



U, S. NAVY MEDICAL NEWS LETTER 



orbits, man was required to be in the vehicle. Beyond 
three orbits the system is no longer fully automatic; 
it is a man-machine combination in which the man 
assumes a most important and vital role. For future 
manned space flights, man and machine will be treated 
as a single entity, each depending on the other for suc- 
cessful mission completion. 

In Project Gemini two men will ultimately orbit the 
earth for periods up to 2 weeks. Gemini will be a test 
bed for Project Apollo. Here we can test equipment, 
train and observe astronauts, and develop techniques 
in space rendezvous and docking. 

Project Apollo calls for extended earth orbital flights 
and for landing men on the surface of the moon during 
this decade. It is planned that two men will land and 
explore the surface of the moon, to a limited degree, 
spending up to 4 hours at any one time, outside their 
lunar vehicle. 

Future plans for man's space explorations go beyond 
the time duration and distance limitations for Project 
Apollo. We look to men being in space vehicles for 
periods over a year or living in permanent lunar or 
planetary bases for even longer periods. Once orbital 
stations and laboratories are in operational use. it is 
conceived that crews will be relieved periodically every 
30 days or so. During the changing of crews and ob- 
servers, the orbiting spacecraft will be resupplied with 
food, oxygen, fuel, and other necessities. This "luxury" 
of relief and resupply will probably not be available for 
interplanetary flights such as to Mars or perhaps Venus. 
There is need for research into the human physiological 
response and performance required for and found dur- 
ing such long-term flights, 

MAJOR HUMAN RESEARCH PROBLEMS 

When we stop to think about it, we realize that for 
the first time we are now placing man in a hostile en- 
vironment in which there is literally nothing to help 
support him. In submarines we may use water to good 
advantage; in high attitude jet aircraft we scoop up 
enough air to compress for man's use; in the Antarctic 
man is able to use much of the natural environment to 
exist. In space, however, only the energy of the sun 
is available for man and this only partially supplies the 
power he requires. He must take his gaseous atmos- 
pheres and pressures and his food, water, and energy 
supplies with him, or perish. 

SUPPLYING RESPIRATORY REQUIREMENTS 

Let us consider our most obvious problem, that of 
supplying man with his respiratory requirements. As in 
Mercury, in Project Apollo we plan to use pure oxygen 
at a pressure of 5 pounds per square inch. The Rus- 
sians have used 14.7 pounds per square inch with ap- 
proximately 20 percent oxygen on all their flights. Al- 
though our 100 percent oxygen systems have proven 
adequate, and hopefully they will continue to be so, I 

U. S. NAVY MEDICAL NEWS LETTER 



fee! that for our advanced missions of over 14 days we 
will be required to go to a mixed gas system of more 
than 5 pounds per square inch. The reasoning behind 
this is the results of research on oxygen toxicity, the 
development of atelectasis in subjects on 100 percent 
oxygen, and the results of studies in radiation effect 
on living tissue that is saturated with 100 percent oxy- 
gen. 

Because of restrictive weight penalties, we are re- 
quired to reclaim all the unused oxygen from the astro- 
nauts' expired breath. As of now, and for our future 
flights, the carbon dioxide and trace contaminants must 
be removed chemically from the expired oxygen prior 
to re-use by the astronaut. For more advanced systems 
this carbon dioxide will be broken down into carbon 
and oxygen. The carbon will be used for radiation 
shielding; and, of course, the oxygen will be used for 
the gaseous atmosphere. 

The reclaimed water may also be hydrolyzed produc- 
ing hydrogen which can then be combined with the car- 
bon to produce methane, which can be further synthe- 
sized to form formaldehyde and finally various sugars. 
Again, the oxygen will be used for breathing. Thus, 
future vehicles and planetary bases will utilize each 
atom of material available, producing usable oxygen 
and edible sugars from the carbon dioxide and water 
produced by the body metabolism of man. 

In using a mixed gas system, we must find an inert 
gas with a low diffusion factor that is non-toxic, light, 
and easily obtained, handled and stored. We know 
something about the physiological effects of nitrogen; 
we know less about helium and very little about argon, 
neon, and other rare inert gases. It appears reasonable 
at this point to predict that nitrogen will be chosen for 
our early extended flights. However, our on-going re- 
search into these other gases may prove this view 
wrong. 

To protect the present-day astronaut from the effects 
of losing his capsule pressures, we place him in a full 
pressure suit. Should his capsule be struck by a meteo- 
roid or in any manner lose its atmospheric integrity, 
the astronaut without his suit would be exposed to a 
vacuum. The dissolved gases within his blood and 
body tissue would immediately be released and he would 
suffer death within a very short time. 

The full pressure suit is air impervious and it fully 
encapsulates the man. When the capsule pressure drops 
below 5 pounds per square inch, the suit valve closes 
and air pressure within the suit supplies enough pres- 
sure to keep the man fully surrounded by 5 pounds of 
air pressure. The suit is a necessary safety device, but 
it is cumbersome when under pressure; and, under nor- 
ma! operation conditions it requires a high ventilation 
flow of dry cool air to keep the astronaut from suf- 
fering from heat and his own sweat. Incidentally, the 
full pressure suit is a primary piece of fire-fighting 
equipment. In space the most expeditious and safest 



19 



means of putting out a fire within the capsule is to open 
the capsule, thus creating a vacuum within. Without 
oxygen the fire dies. The suit keeps the man at 5 
pounds per square inch. 

Here again, it is my personal opinion that we cannot 
keep our future astronauts in the present full pressure 
suit for prolonged periods. We are hard at work trying 
to devise methods of affording the astronauts the safety 
features of a full pressure suit with the comforts and 
facilities of a "shirt-sleeve" environment. This is no 
easy task. 

Furthermore, future space operations require extra- 
vehicular maneuvering of men in free space as well as 
on lunar and planetary surfaces. Here the man will be 
required to work in varying degrees of a weightless 
state, and thus in reduced or frictionless environments. 
He will be subjected to extremes in temperatures, brilli- 
ant light or extreme darkness, and, of course, to radia- 
tion hazards. We must devise and provide adequate 
protective extravehicular suits for individual space men 
with reliable independent life support systems and self- 
maneuvering devices. 

PROBLEMS OF ACCELERATION FORCES 

Another major area of concern to the space surgeon 
is that of acceleration. In order to withstand the ac- 
celeration forces required to boost a vehicle into orbital 
or escape speeds, we place man on his back facing the 
line of flight. Thus, the acceleration forces during the 
boost phase are exerted on him and his organs trans- 
versely from chest to back. Should he be in a seated 
position, the acceleration forces would act from his 
head to his buttocks. Pressures would build up within 
the cardiovascular system that would prevent sufficient 
blood from reaching the brain, and thus cause uncon- 
sciousness. Prolonged ischemia can cause permanent 
cerebral damage. In a horizontal position the cardio- 
vascular system becomes a horizontal pumping system. 
Thus, the blood cannot pool in dependent organs and 
limbs. There is little build-up of hemodynamic pres- 
sures, and the heart has the capacity to pump blood into 
the brain. The period of useful consciousness is greatly 
extended during prolonged acceleration forces. 

Each astronaut has a custom-made, form-fitting 
molded couch in his vehicle. By this fact, when ac- 
celeration forces increase the body weight, these ex- 
cessive forces are distributed equally throughout nearly 
one-half his entire body surface. He can remain rela- 
tively comfortable through prolonged high G force 
phases of flight. 

PROBLEMS OF WEIGHTLESSNESS 

Another environmental factor of considerable con- 
cern that is receiving a great deal of scientific attention 
is weightlessness. 

Once through the acceleration phase, the astronaut 



suddenly finds himself weightless. Under this condition 
nothing has weight. Thus, the blood within the blood 
vessels is as weightless as any other portion of the body 
or anything in the vehicle. Weightlessness is a phe- 
nomenon caused by the speed of the vehicle counter- 
acting the gravity force of the earth. At a speed of 
17,500 miles per hour, the vehicle will rotate about 
the earth at approximately 100 miles of altitude in a 
relatively fixed orbital path. 

Theoretically, should the earth's gravitational pull 
suddenly cease, a speeding orbital vehicle would shoot 
away from the earth in a straight line tangential to the 
earth. The balance between the speed of the vehicle 
and the earth's gravitational pull is a delicate one. The 
firing of the retrorockets slows the vehicle only about 
350 miles per hour, but this is enough to allow gravity 
to take over and bring the vehicle gradually toward 
the earth. Once the capsule begins to contact the at- 
mosphere, the resistance to the speeding vehicle in- 
creases and the deceleration rate increases. 

To date, effects of weightlessness have not been 
detrimental to man in space. However, we have reason 
to believe that over longer periods of time weightless- 
ness may take its toll in producing adverse physio- 
logical effects. Most of us are well aware of the reac- 
tion of well and healthy individuals who have been re- 
stricted to absolute bed rest for prolonged periods. 
First, upon rising they become faint, developing varying 
degrees of syncopal symptoms from blanching to loss 
of consciousness. Secondly, should they be kept on 
their feet, they develop dependent edema, or swelling 
of the feet and ankles. The same effect has been noted 
in subjects who have been fully submerged in water 
during studies of neutral buoyancy. The cardiac action 
and capacity have changed and cannot react quickly to 
the alterations in the hemodynamics of the changed po- 
sition of the body. Again, the characteristics of the 
peripheral vascular system have changed. The arteries 
and veins of the lower portions of the body do not ac- 
commodate the blood, and the tissues become edema- 
tous. The kidney function is altered, with noticeable 
increase in urine output. 

A very serious effect of prolonged bed rest and 
neutral buoyancy is that of a shift in the body metabo- 
lite balance. The major shift is a marked increase in 
blood calcium which is subsequently excreted by the 
kidneys. This increase is due to a rather early and 
definite demineralization of the hones. This factor has 
been noted in examining the astronauts after Project 
Mercury flights. We do not know the mechanisms that 
cause these physiological changes in the basic functions 
of the body. We have no idea how far the cardiovascu- 
lar system adapts to the dynamics of weightlessness or 
how great demineralization becomes before the process 
slows or stops, if in fact it does stop. 

With the thought that bed rest without exercise 
caused the aforementioned changes, the experimenters 



20 



U. S. NAVY MEDICAL NEWS LETTER 



had half of the subjects do vigorous exercises while re- 
maining fiat on their backs. The exercise worked won- 
ders for the muscular system, but the results on the 
cardiovascular system and the metabolic processes were 
the same as for those who did no exercising. 

What can this mean to the astronaut if these changes 
progress over several weeks or months of weightless- 
ness? First, the cardiovascular system and the bony 
structure of the body may fail upon being subjected to 
the relatively prolonged and high acceleration forces 
experienced during reentry. Loss of consciousness, 
myocardial insufficiency, or complete cardiac failure 
may result. Fractures may result from the loss of ade- 
quate bone structure. We may well be required to place 
a successfully returned astronaut in a rehabilitation cen- 
ter where he will gradually regain bodily activity and 
learn to walk again. The one-gravity field we know 
and react to so well here on earth will be strange to the 
astronaut. 

RADIATION HAZARDS 

A third major hazard to which we have turned con- 
siderable attention is that of radiation. The effects of 
certain radiations are well known to us. We have de- 
veloped equipment to produce a variety of radiation 
energies and particles and have exposed biological 
specimens to these hazards. However, we still know 
very little of the biological effects of mixed radiation 
energies and the extent of effects due to secondary 
energies received by occupants in spacecraft. Much 
more work must be done to develop better passive and 
active shielding systems for future flights. 

During Projects Mercury and Gemini and through 
the early Apollo flights very little, if any, radiation 
hazards will have been encountered. We are interested 
in the heavy primary strikes from galactic sources but 
as these flights are not scheduled to meet the Van Allen 
Belt concentrations, there is little concern for the astro- 
naut. The later Apollo nights will be required to pass 
through the earth's geomagnetic fields and into outer 
space where the full energies of the sun and its solar 
flares will be met. We have not been successful in fully 
mapping this space for its radiation hazards nor have 



we accurately defined the concentrations and varieties 
of the mixed radiation energies to be met. 

Additional hazards will result when men leave the 
protective shell of the vehicle for extravehicular work 
in free space or on the lunar surface. Added biological 
effects of radiation exposure may result from using 100 
percent oxygen during these extravehicular operations. 

Future plans call for active shielding systems that 
may well place a man in a vehicle surrounded by a 
strong electromagnetic field that will repel or trap the 
particles much as our own earth's geomagnetic fields 
do. What effects these high-magnetic fields have on 
man is still unknown. Another facet of study concern- 
ing electromagnetic fields involves the biological effects 
of null or low field forces and, of course, the effects 
on living tissue passing through varying magnetic field 
forces. We are extensively studying animals and men 
in altered magnetic fields and hope to have definite 
answers in the near future. 

CHANGE OF COMMAND CEREMONY AT 
U. S. NAVAL AVIATION MEDICAL CENTER 

On 4 November 1964 in a formal military Change of 
Command Ceremony, RADM James L. Holland, MC 
USN relieved RADM Langdon C. Newman, MC USN 
as Commanding Officer of the U. S. Naval Aviation 
Medical Center, Pensacola, Florida. 

Present on the Reviewing Stand were: Vice Admiral 
A. S. Heyward, Jr., USN, Chief of Naval Air Training; 
Rear Admiral Daniel F. Smith, USN, Chief of Naval 
Air Basic Training; Rear Admiral Robert B. Brown, 
MC USN, Deputy and Assistant Chief of the Bureau of 
Medicine and Surgery; Rear Admiral Herbert H. 
Eighmy, MC USN, Assistant Chief for Personnel and 
Professional Operations, Bureau of Medicine and 
Surgery; and other military and civilian dignitaries. 

Rear Admiral Holland recently was assigned as Fleet 
Surgeon on the Staff of the Commander in Chief. 
United States Pacific Fleet. Rear Admiral Newman's 
next assignment will be in the Bureau of Medicine and 
Surgery as Assistant Chief for Research and Military 
Medical Specialties. 



CANCER MUST BE TREATED EARLY 

Early diagnosis and treatment holds the best hope 
for cure. Two ways to protect yourself: Have an an- 
nual health examination and be alert to cancer's seven 
danger signals. Get copies of the seven danger signals 
by calling or writing to your local American Cancer 
Society. 



DIET COUNSEL FOR HOMEBOUND 

In Newark, N. J., a nutritionist, provided through 
the Visiting Nurses Association, teaches homebound 
patients how to select and prepare foods for new or 
modified diets. The fee charged for the service is ad- 
justed for patients unable to pay full or partial costs. 
—Public Health Reports 78( 12) : 1060, December 1963. 



U. S. NAVY MEDICAL NEWS LETTER 



21 




MISCELLANY 



LCDR RICHARD A. MILLINGTON, MC USN, 
RECEIVED THE NAVY COMMENDATION 
MEDAL FROM THE SECRETARY OF THE 
NAVY ON 19 OCTOBER 1964 FOR SERVICE 
AS SET FORTH IN THE FOLLOWING 
CITATION: 

"For meritorious achievement while serving with Air 
Development Squadron SIX (VX-6) on the flight from 
Capetown, South Africa to McMurdo Station, Antarc- 
tica on 30 September-October 1963. As a special crew 
member of a ski-equipped LC-130F Hercules aircraft, 
LCDR Mitlington, through his professional skill and 
meticulous attention to detail, contributed materially to 
the successful completion of this pioneering and trail - 
blazing, nonstop flight of 4,700 miles over unknown 
waters of the South Atlantic Ocean and the uncharted 
wastes of Antarctica. His fortitude and devotion to 
duty were in keeping with the highest traditions of 
the United States Naval Service." 



CASES OF BOTULISM— HIGHEST 
YEARS 1899-1963 





CASES 


DEATHS 


YEAR 


1st 


89 


56 


1919 


2nd 


71 


43 


1935 


3rd 


63 


22 


1921 


4th 


59 


48 


1922 


5th 


50 


31 


1924 


6th 


48 


31 


1931 


7th 


47 


18 


1939 


8th 


47 


14 


1963 


9th 


46 


34 


1932 


10th 


44 


32 


1941 



SOURCE: 1899-1949— Meyer, K. F. and Eddie, B. 
•'Fifty Years of Botulism in the United 
States and Canada," George Williams 
Hooper Foundation, University of Cali- 
fornia, San Francisco. 1950-1963 — State 
Reports received by NOVS and CDC. 



BOTULISM 

Four cases of botulism were reported from Cali- 
fornia recenty making the cumulative total of cases 
reported thus far in the United States this year 15, 
compared to 34 for a similar period in 1963. The 4 
cases from California represented an outbreak attributa- 
ble to home canned peppers. California leads all other 
States in the number of cases reported this year, with 
a total of 7. 

The majority of cases in 1963 were due to com- 
mercial products whereas this year, all cases have been 
attributed to the consumption of home canned products. 
No cases of type E botulism have been reported to 
date this year. 

The following table presents the number of cases of 
botulism outbreaks for the 10 highest years since 1899. 



NAVY NURSE GIVEN MEDAL FOR 
PERFECT SCHOOL RECORD 

Boulder, Colo. — Lieutenant Phyllis J. Elsas, Navy 
Nurse Corps, has received the University of Colorado's 
Distinguished Service Medal for outstanding perform- 
ance of obtaining a perfect scholastic record. 

She is the only person in the history of the school to 
graduate with perfect marks. 

The presentation was made here during a Navy Day 
review at the university. (AFPS-Nov, 8, 1964) 

THERMOMETERS 
(BAGGING TO REDUCE CROSS INFECTION) 

A new technic of bagging thermometers to reduce 
cross-infection in hospitals has been developed in Den- 



22 



U. S. NAVY MEDICAL NEWS LETTER 



mark. Thermometers are sterilized by immersion in 
1:1000 Zephiran (benzalkonium) chloride solution for 
two hours. After washing and drying each thermometer 
is placed in a small cellophane bag. The ward nurse 
hands the bag to the patient who removes the thermom- 
eter, takes his temperature, and replaces the ther- 
mometer in the bag. The nurse reads the thermometer 
through the cellophane. The bagged thermometer is then 
returned to the central sterilizing room. Thus, no one 
in the ward except the patient handles the thermometer 
between one sterilization and the next. — Med. News 
(London, Eng.), No. 102, Sept 18, 1964.— Clin-Alert®, 
No. 302, Nov 3, 1964 (by permission). 



DIRECTOR, NAVY NURSE CORPS' 
CONFERENCE 

The Chiefs of Nursing Service of all naval hospitals 
within the continental limits of the United States at- 
tended a 3 day Navy Nurse Corps Director's Confer- 
ence from 14-16 October at the National Naval Medi- 
cal Center, Bethesda, Maryland. Captain Ruth A. 
Erickson, NC, USN, convened the meeting for the 
Senior Nurse Corps officers. Captain Dorothy P. Mon- 
ahan, NC, USN, Deputy Director, moderated the pro- 
gram. 

Rear Admiral C. B. Galloway, MC, USN, Com- 
manding Officer of the National Naval Medical Center, 
welcomed the senior nurses during the opening session. 
Following this, Rear Admiral Robert B. Brown, MC, 
USN, Deputy Surgeon General, addressed the con- 
ferees. 

Captain Erickson spoke to the senior nurses through- 
out the program in areas concerning the theme of the 
meeting, "Today's Action Determines Our Tomorrow." 
She presented a profile of the Corps; discussed an on- 
going research project on retention of nursing person- 
nel; explained personnel policies for assignment, edu- 
cation, and advancement of nurses; probed problem 
areas; and voiced her concern about the current critical 
shortage of nurses. Captain Erickson also informed the 
Chief Nurses of continuing projects and activities that 
will be of assistance to nursing services and the Nurse 
Corps. 

Other highlights of the meeting included various 
presentations by selected Chiefs of Nursing Services, 
by members of the Education and Research Branches 
of the Naval Medical School and by members of the 
Nursing Division staff. The individual speakers inter- 
wove subjects on utilization of nursing personnel, tele- 
vised programmed instruction for nurses, counseling 
and guidance techniques, management, and research as 
areas of action being undertaken today that will serve 
to improve the Nurse Corps tomorrow. 

Other distinguished guests included Dr. D. George 
Kousoulas, Dr. John C. Lang, and Dr. Esther Lloyd- 



Jones. Professor Kousoulas, a faculty member of 
Howard University, discussed "Perspectives of the Com- 
munist Movement Today." Dr. Lang, Head of the 
Curriculum and Instruction Branch, Bureau of Naval 
Personnel, Washington, D. C, spoke on "in Navy Edu- 
cation and Training." Professor Lloyd-Jones, Head of 
the Department of Guidance and Student Personnel 
Administration, Teachers College, Columbia University, 
New York, discussed "Programming for Guidance and 
Counseling in Nursing Service." — Nursing Division, 
BuMed 



THE VALUE OF A NAVY CAREER* 

By LCDR J. P. Kirsch, MSC USN**. From Supple- 
ment Prepared by the Great Lakes BULLETIN in 
Celebration of NAVY DAY, 1964. 

Value is a relative term, therefore it must be related 
to specific items to have real meaning. 

First, when related in terms of money (which is un- 
derstandable to everyone) the value of a Navy Career 
can be measured in dollars and cents. To a young man 
entering the Navy as a seaman recruit and who is will- 
ing to work and study hard for 30 years — it can equal 
an investment of more than $150,000 at 4% per year. 
In other words, he can retire at $570 per month for 
life. 

Second, when related to education — it can mean 
learning a profession by taking advantage of the Navy's 
A, B, and C schools. It can mean gaining a high 
school diploma or a college degree at night under Navy 
sponsorship and with Navy financial aid. It can mean 
full time college training under the NESEP program or 
even education at the Naval Academy. And for the 
ones who are real energetic, it can mean a master's 
degree through postgraduate school in the Navy or a 
civilian university at Navy expense and at full pay. 

Third, when related to prestige — it can mean rising 
from the average status of a recruit through the en- 
listed ranks to become a commissioned officer. This 
can be done through many different programs — MSC, 
NESEP, Warrant to LDO, or Naval Academy. When a 
man has worked his way up through the enlisted rates 
and into the commissioned officer ranks, he has gained 
the respect of his contemporaries and seniors alike — 
he has prestige that can be questioned by no man. 

Fourth, when related to security — the value of a 
Navy career is knowing that you have a job and a pay 
check for as long as you are willing to work hard and 
put forth your best, knowing your health will be pro- 
tected and that you will receive free medical and dental 
care — while receiving full pay — by the very best medi- 
cal and dental personnel, knowing that your wife and 
children will receive medical care at military or civilian 
hospitals, and knowing that, if adversity strikes, "The 



U. S. NAVY MEDICAL NEWS LETTER 



23 



Navy takes care of its own" through its allied organiza- 
tions. And finally, you know that you can retire after 
20 years of service if you so desire. 

Fifth, when related to patriotism — the value of serv- 
ice to our country is intangible and cannot be meas- 
ured — yet it is the most important of all. Learning love 
for our country through service in peace and war has 
a way of going deep inside of a man. A love which 
puts a lump in his throat or a tear in his eye every 
time he sees our flag raised or hears our National 
Anthem played. These values cannot be bought or sold 
— money does not affect them, they are instilled through 
the esprit de corps of naval service. 

Do these values sound a little far fetched? 
Seaman Recruit to Lieutenant Commander 
$570 a month for life at retirement 
A college education 
Prestige as an officer 
Personal health security 
Family health security 
An intense love of our country through service in 

protecting and perpetuating the greatest country 

in the world. 

A little unbelievable? A touch of Horatio Alger? 
Perhaps . . . but I can prove it — it happened to me! 



* Nine winners of the Navy Day Essay Contest at the U. S. Naval 
Training Center, Great Lakes, Illinois, were awarded their prizes 
Friday, Oct. 16 by Captain E. G. Sanderson, USN, Center Com- 
mander. 



All center personnel and their dependents, over 
for the contest. 



were eligible 



The contest consisted of three categories. "The Value of a Navy 
Career" was category one in which officers and enlisted men on 
their second tour of duty were eligible. "Why 1 Chose The Navy" 
was category two which included first tour personnel, both officer 
and enlisted. "Challenges Facing Navy Dependents" was category 
three which included Navy dependents. 

First place winner in category one was Lieutenant Commander, 
J. P. Kirsch, NEC. LCDR Kirsch won a 16-inch portable TV. 
Second and third place prizes went to G, S. Johnson, CS2 and W, H. 
Arthur, HM3. They received portable radios. 

In category two. first prize went to Elizabeth Martin. SA. Wa\e 
Admin; she was awarded an RCA transistor radio. Second and 
third place winners were Lieutenant (jg) A. P. McLaughlin of 
DPWO and B. J. Wilson, SA, Public Works. Both were awarded 
a six-transistor radio. 

"Challenges Facing Navy Dependents," the third category, was 
won by Mrs. Patrick C. Racey. Mrs. Racey was awarded an auto- 
matic washer. The second place prize was a stereo phonograph 
awarded to Miss Anita Anthony. Mrs. G. M. Molm won a radio. 

An honorable mention was given to Miss Kamona Federle, a 12- 
year-old dependent. Captain Sanderson commended her on the 
thought and originality she showed for such a young girl. 

** Lieutenant Commander Kirsch, a resident of Mundelein, Illinois, 
and a native of Hills, Minnesota, is currently attached to the Naval 
Examining Center. Happily married, and the father of three children. 
He admits, in his essay, to being a 30-year career man. 



DR. WALTON JONES NAMED ACTING 
HEAD OF NASA BIOTECHNOLOGY 

Dr. Walton L. Jones, Jr., became Acting Director of 
the Biotechnology and Human Research Division at 
Headquarters, National Aeronautics and Space Ad- 



ministration, effective Oct. 26. He succeeded Dr. Eu- 
gene B. Konecci who resigned to join the staff of the 

National Aeronautics and Space Council, 

The assignment was announced by Dr. Raymond L. 
Bisplinghoff, NASA Associate Administrator for Ad- 
vanced Research and Technology. 

The Biotechnology and Human Research Division is 
concerned with research and advanced technology for 
the support of man in aeronautical and space flight and 
the means to assure his capabilities in extended flights. 

Dr. Jones joined the division May 5, and later suc- 
ceeded Dr. Frank B. Voris as Head of the Human Re- 
search Branch. Dr. Jones is an active duty Captain 
and Flight Surgeon in the U. S. Navy Medical Corps. 
Before coming to NASA he was Director of the Avia- 
tion Medicine Technical Division of the Navy's Bureau 
of Medicine and Surgery. 

—NASA News. Release No. 64-268, October 23, 1964. 



MORTAR SHELL CASUALTIES FROM BIEN 

HOA AIRBASE TREATED AT U. S. NAVY 

STATION HOSPITAL, SAIGON 

Viet Nam, 2 Nov 1964 — Fifteen hours after com- 
munist Viet Cong mortar shells began falling on U, S. 
Military planes and personnel at Bien Hoa Airbase, 
Navy doctors, nurses and corpsmen at the U. S. Navy 
Station Hospital here were still treating the wounded. 
Casualties began arriving by helicopters shortly after 
2 A.M. this morning and were rushed to the hospital 
which cares for U. S. Military personnel wounded in 
combat in the southern part of RVN. The hospital's 
fleet of ambulances shuttled wounded from a medical 
evacuation Helo landing field most of the morning. 
The field is a six-minute ride from the hospital emer- 
gency and operating rooms. A few minutes after re- 
ceiving word of the action about 2 A. M., the hos- 
pital's entire staff was alerted and went into action. 
As the wounded arrived, the extent of their injuries 
was determined and each casualty received immediate 
treatment accordingly. By 2 P. M., 14 U. S, Army and 
2 USAF enlisted men had been treated for wounds 
received in the Bien Hoa attack. By that time, only 
two were reported on the serious list and one was 
described as critical. The U. S. Navy Station Hospital, 
Saigon, which is the only U. S. Navy medical facility in 
the world involved in the treatment of war-wounded 
direct from the field of action, is especially set up to 
handle mass combat casualties. It has a staff of 9 
Navy Medical Officers, 2 Medical Service Corps offi- 
cers, 8 Navy Nurse Corps Officers, and 73 Navy 
Hospital Corpsmen. The hospital is a facility of the 
U. S. Navy Headquarters Support Activity, Saigon, 
Commanded by Captain Archie C. Kuntze, U. S. Navy. 



24 



U. S. NAVY MEDICAL NEWS LETTER 



Training Notice 



NEW INFORMATION ON AFIP POST GRADUATE SHORT COURSES 
FOR SECOND HALF OF FISCAL YEAR 1965 



In the U. S. Navy Medical News Letter issue of 23 
October 1964, Vol. 44. No. 8, page 25, there were 
listed the postgraduate short courses for FY 1965 
scheduled at U. S. Army facilities and at the Armed 
Forces Institute of Pathology. The following two 
courses are added to that list: 



The inclusive dates for the Annual Armed Forces In- 
stitute of Pathology Lectures — 1965, should be 29 
Mar-2 Apr 1965 MC, instead of the dates listed in the 
above reference (15-19 Feb 1965 MC).— Editor 



Courses 


Location 


Date 


Corps 


Forensic Pathology 


AFIP 


11-15 Jan 65 


MC 


Ophthalmic Pathology 


AFIP 


12-16 Apr 65 


MC 



IMPORTANT CORRECTION NOTICE FOR 

U. S. NAVY MEDICAL NEWS LETTER OF 

23 OCT 1964, VOLUME 44, 

NO. 8, PAGE 24 

Reference is made to paragraph 4d (2) (a) of 
BUMED INSTRUCTION 6230.1 1C; which is cor- 
rected to read as follows: 

"The tablet size for pyrimethamine, used in pediatric 
practice for malaria suppression, is incorrectly stated in 
BUMED INSTRUCTION 6230. 11C. The correct size 



is 25 mg., the only size available commercially. For 
greater convenience in use, the dosage has been recom- 
puted on an age basis instead of a body weight basis. 
As given in ALNAV No. 44, the correct dosage is now 
12.5 mg. (one-half tablet) once weekly for children ages 
1 through 14 years, and 6.3 mg. (one-fourth tablet) 
once weekly for infants under one year of age." 

Holders of the above issue of the Medical News 
Letter are requested to make these important changes 
in pen and ink. — Editor 



WHO AIDS TUBERCULOSIS CAMPAIGN IN PERU 

The Government of Peru; with the assistance of the 
Pan American Sanitary Bureau (WHO Regional Office 
for the Americas) and UNICEF, is to conduct a cam- 
paign against tuberculosis among the 100,000 inhabi- 
tants of its three southernmost provinces, Tacna, 
Tarata, and Mariscal Nieto. In Tacna, which borders 
on Chile and has an area of 4182 square miles, the 
tuberculosis case rate for 1961 was 760 per 100,000 
population as against 425 for the entire country. 

The aim is to take radiographs and carry out tuber- 
culin tests of at least 80% of the population of the 
three provinces between 1964 and 1966. Mass BCG 
vaccination programmes will protect those in good 
health and tuberculosis sufferers will receive drug treat- 
ment. WHO is to provide technical personnel, including 
a tuberculosis specialist, a statistician, and a public 
health nurse, and it will also give fellowships to Peruvian 
health workers to study tuberculosis control methods 
abroad. UNICEF will provide $58,000 worth of equip- 



ment and supplies, including a mobile x-ray unit. The 
Government of Peru will meet the local costs of the 
programme, which are estimated to be $46,000 a year. 
—WHO Chronicle 18(9): 357, September 1964. 

HOME NURSING FILM 

A motion picture series of 10 half-hour films, en- 
titled "The Home Nursing Story," makes it easier for 
persons to learn how to safeguard family health, to 
know what to do when illness strikes and how to care 
for the sick and injured if disaster disrupts family life. 
The series was made for the American Red Cross by 
the Army Signal Corps, with funds provided by the 
Office of Civil Defense. 

A companion workbook contains tips on teacher 
preparation and how to present the films. It also lists 
possible followup activities. Information about loan 
or purchase of the film series may be obtained through 
local American Red Cross chapters. — Public Health 
Reports 78(12): 1060, December 1963. 



U. S. NAVY MEDICAL NEWS LETTER 



25 



CONTENTS 



MEDICAL ABSTRAC TS 

Postoperative Pain 

Mobile Emergency Cart for Intensive Care Ward- 
USNH, Newport. Rhode Island 

FROM THE NOTE BOOK 

Recent Changes in Medical Training Programs 

3 Navy Doctors Win Awards at Armed Forces 

Ob-Gyn Seminar 

Dr. Kazmierski First Woman Optometry Officer in 

the Navy 

The Value of "Intensive Care" Training 

American Board Certifications 

NEW SECTION 

A Look at Our U. S. Naval Hospitals — Bremerton, 

Washington 

DENTAL SECTIO N 

Evaluation of Direct and Indirect Pulp Capping 

The Oral Tissues' Response to Ultrasonic Instru- 
mentation 



12 



12 



DENTAL SECTION (Cont'd) 

Thermal Conductivity of Restorative Materials and 

Cavity Liners 

Objectives of Dental Education 

Personnel and Professional Notes 



AVIATION MEDICINE 

Medical Aspects of Space Flight 

Change of Command Ceremony at U. S. Naval 

Aviation Medical Center 



MISCELLANY 

Presentation of Navy Commendation Medal 

Botulism 

Navy Nurse Given Medal for Perfect School Record 
Thermometers (Bagging to Reduce Cross Infection) 

Navy Nurse Corps' Conference 

The Value of a Navy Career 

Dr. Walton Jones Named Acting Head of NASA 

Biotechnology 

Mortar Shell Casualties from Bien Hoa Airbase 

Training Notice 



12 
13 

14 



18 
21 



22 
22 
22 
22 
23 
23 

24 

24 
25 



DEPARTMENT OF THE NAVY 

U. S. NAVAL MEDICAL SCHOOL 

NATIONAL NAVAL MEDICAL CENTER 

BETHESDA. MARYLAND 20014 

OFFICIAL BUSINESS 



POSTAGE AND FEES PAID 
NAVY DEPARTMENT 



PERMIT NO. 104S 



26 



U. S. NAVY MEDICAL NEWS LETTER